Comparison of Doppler Echocardiographic and Invasive Hemodynamic Methods for Optimization of Patients Receiving Cardiac Resynchronization Therapy

Authors : Hafize Corut Güzel, Elif Sade

Pages : 100-106

View : 37 | Download : 49

Publication Date : 2025-07-28

Article Type : Research Paper

Abstract :Introduction: Cardiac resynchronization therapy (CRT) is a novel treatment for heart failure patients. Our study investigated the positive effects of pacemaker optimization in patients who respond poorly to CRT. We aimed to compare the acute and mid-term effects of invasive and echocardiographic optimization methods on hemodynamic and volume response after CRT. Methods: In this study, we compared invasive and echocardiographic methods to adjust AV and VV delays. We randomly divided 40 patients into two groups: 20 tested by echocardiography and 20 by invasive method. Initially, AV (60-160 ms) and VV (-60 to +60 ms) delays were measured by both methods and then patients were divided into groups for follow-up. The best delays were assessed by measuring left ventricular outflow tract velocity-time integral (LVOT-VTI) and diastolic filling time (DFT) on echocardiography and dP/dtmax on the invasive method. At the end of 6 months, a volume response of ≥15% decrease in volume and a volume response of >5% increase in EF was considered as ≥1 improvement in NYHA. Results: Initially determined optimal AV delays were consistent within ±10 ms in 57.5% of patients, and VV delays were consistent within ±20 ms in 65% of patients. Significant improvement in acute hemodynamic response was observed with echo-guided optimization (DFT: from 360±123 ms to 467±137 ms; p<0.001 and LVOT-TVI: from 13.5±4 cm to 16±4.4 cm; p<0.001). With invasive optimization, LV dP/dtmax increased from 1088±327 dynes/s to 1336±327 dynes/s (p<0.001). At 6 months, with invasive optimization, 70% of patients were clinical responders, 40% were volume responders, and 70% were EF responders, while with echo-guided optimization, these rates were 45%, 60%, and 60%, respectively (p=NS). The optimization method did not predict clinical or volume response at 6 months. Conclusion: Both invasive hemodynamic and echocardiographic Doppler methods are comparable and effective for CRT optimization.
Keywords : Kalp Yetersizliği, İnvazif, Ekokardiyografi, Kardiak Resenkronizasyon Tedavisi, Optimizasyon

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